This article was originally posted on Woy Magazine
Despite the many efforts of the health ministry and its partners, the Haitian sanitary landscape is plagued by chronic and infectious diseases and trauma. Half of the country’s population suffers from hypertension (EMMUS V) , and four years ago, a major cholera outbreak erupted killing thousands of people. Unfortunately, the level of sanitary education in the Haitian population remains among the lowest. These factors, coupled with some of the worst conditions in the northern hemisphere contribute to the 61-64 year life expectancy (EMMUS V). In the midst of this catastrophic public health state, a staggering number of physicians leave Haiti year after year, further exacerbating the 2 doctors for 10,000 inhabitants ratio. Why is Haiti’s health sector experiencing such an exodus? This article’s aim is not to exhaustively analyze all of the reasons why Haitian physicians leave, but to discuss the reasons I have observed among my peers.
Poor financial reward
A licensed doctor- either a general practitioner or a specialist- employed by a state health care institution, earns around 32,000 HT gourdes a month. This is the equivalent of US $7,384.61 a year, according to the national bank exchange rate. While some doctors run private clinics, it is not uncommon for many to work for more than one institution in order to earn a decent living. In this field, as in any other in Haiti, it is difficult to secure a good job, and clinics bring less and less income because people lack the means to pay private doctors. It should be noted though, that some doctors who own private practices are very successful.
Let us dare a comparison: In France, the average net salary of a general doctor is € 6, 664 a month (UNASA, 2012); which is the equivalent of US $103,958.4 a year (€ 1 = US $ 1.3 in april 2012). As Atul Gawande stated in his book Better: A surgeon’s notes on performance, in 2003, the median income for primary care physicians in the USA was $ 156,902, and for general surgeons, it was $ 264,375. Active orthopedic surgeons, cardiologists, pain specialists, oncologists, neurologists, hand surgeons and radiologists frequently earn more than half a million dollars a year.
Inappropriate work environment
In addition to the poor financial reward of practicing medicine in Haiti, the work environment is not ideal. When it comes to the health care system, one can easily notice a significant difference between reality and what is reported. Poor governance by the ministry of health has led to a residency fiasco, where a group of state students have used intimidation and false propaganda to make the ministry withdraw previously held fair policies. The programs themselves are poorly run in terms of leadership and mentoring. A lack of proper andragogy plagues the tutoring program, and fear and brutality are frequently used teaching methods. Therefore, the results are far from what is expected; the physician, who is supposed to be the kindest human being, tends to lose his/her humanity in such a situation. This sense of humanity is also slapped on a daily basis by the uncleanliness and the unpleasant odor of the work place
The health care system is broken in so many ways, it seems like we do not have the necessary administrators to fix it. The eternal war between public and private medical schools can prove this fact. As a result of the weaknesses of the system, the hospitals lack even the basic materials like sheets for the beds, gloves for doctors and nurses and sterilized equipment. Often, the materials available are so outdated; they can not be properly used to save a life in a matter of minutes.
Lack of continuing education opportunities
For the doctor, education does not stop the last day of medical school or residency program. Practicing medicine is a lifetime commitment to study and research. It would be unfair not to acknowledge the efforts of the health ministry to provide Continuing Medical Education in Haiti. But again we are faced with the inequity issue, as these opportunities are not available for every doctor. In fact, not enough resources, mainly live events, are available for the number of physicians requiring such initiatives in Haiti. In the USA, the American Medical Association has gathered resources to help physicians meet their professional goals. These resources include things such as: live events, written publications, online programs, audio, video, or other electronic media.
Lack of Confidence
Haitian doctors are aware of the worldwide situation of the medical science. Thanks to globalization, foreign doctors can personally engage with doctors in Haiti and vice-versa, to learn from each other and improve their skills and medicine in general. On such occasions, a feeling of low self-esteem seems to conquer too often the minds of even well trained Haitian doctors. As a consequence of the previous flaws described, there is a feeling of shame that adds to the burden. The lack of confidence makes many Haitian doctors doubt their skills. As one stated in a conversation: “… [I would] rather be a good nurse in the USA or Canada instead of being an unqualified doctor in Haiti.” While Haitian doctors have shown impressive skill and judgment no matter how poor the work setting, low self-esteem remains a poison.
How is it possible that our basic conditions are so unsatisfying? Over the years, I have realized that arrogance, greed and incompetence are given the priority over what truly matters. Politicians only care about their own agenda instead of the health of the people. Therefore, bad governance leads to such unresolved crises. The status quo is guarded by people who are in position of power as long as it is profitable for them. Exclusion is then the norm. We must tackle all of these issues to prevent this massive exodus of young Haitian doctors.
I personally work with people who dream to become cardiac surgeons, army surgeons, health system designers, health care entrepreneurs, world-class professors, genetic researchers and more. I work every day with people who are motivated to pursue and conquer their dreams. The ambition is palpable. But where in Haiti can a doctor receive such training? How can a Haitian doctor lead such a fruitful career without eventually leaving one day?
Let me be clear, I do not wish to judge the quality of medical training in Haiti. I do not have the competence required to do so. This is what I do know, doctors who refuse to settle for the Haitian system are searching for an inclusive system, better work environments, open opportunities to learn more and greater financial reward. Correct me If I’m wrong, in any well-functioning society, these factors are any professional’s most basic rights.